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Thomas-Love Settlement Q&A
Q: How can I learn more about the Thomas-Love Settlement?
A: You can learn a lot more here:
Q: Can you quickly summarize this for me?
A: Known initially as the “Thomas” case and more recently as the “Love” case, the agreement resolves past disagreements between the Blue Plans and physicians and makes commitments to further promote cooperation and communication with physicians. “Each of the settling Plans and the BCBSA made an independent decision that this agreement is in the best interest of the settling Plans and it will strengthen the settling Plan’s relationships with physicians and benefit its members,” said Michael A. Pope, spokesperson for the settling Plans and an attorney with McDermott Will & Emery.
Similar to previous settlements involving other national health plans, the participating Blue plans have agreed to pay significant sums into a general settlement fund for the plaintiffs and, in a move surely to create high anxiety within the plans themselves, have also agreed under the terms of the agreement to comply with strict deadlines that, among other contract demands:
- Availability of Fee Schedules and Scheduled Payment Dates for up to a specified 100 CPT Codes.
- Greater Notice of Policy and Procedure Changes
- Procedures regarding Initial Determinations
- Termination Without Cause
- Establishing Standard Fee Schedules
- Payment Rules for Injectibles, DME, Administration of Vaccines, and Review of New Technologies
- Adopt new Medical Necessity Definition in Current Agreements
- Policies Involving Clinical Judgment
The affected Plans must now determine how they will comply in a timely and precise manner.
With only one plan still challenging the consolidated litigation, it is only a matter of time before many regional health plans will be facing pressure from medical societies and their attorneys to institute the same measures.
What exactly is Kryptiq Management Consulting? What is Active Progress™?
Kryptiq’s Active Progress™ Consulting Services is a new division of Kryptiq Corporation, the leader in healthcare connectivity, which is committed to delivering innovation exclusively to the health plan market. Active Progress™ closely collaborates with its clients to help them achieve high performance. Our professionals bring leading-edge technologies and business experience to plans to identify opportunities and drive business process improvements, such as the 5th Progression, an acclaimed Capability Maturity Model for Provider Contract Management. With deep health plan and business process expertise, broad resources and a proven track record, Active Progress™ Consulting Services can bring together the right people, skills and technologies to help clients improve health plan performance management. Active Progress™ Consulting Services has identified the requirements of the Thomas-Love Settlement as an area where Kryptiq can provide unique and significant consulting value for health plans.
Q: What exactly are you offering, and how does this help me? Why is Kryptiq a viable choice for helping me?
Kryptiq Management Consulting is providing a comprehensive professional services solution to address the specific deliverables called out by the Thomas-Love Agreement, providing assistance with processes related to:
- Crafting new contract language
- Identifying systems needing update and changes
- Claims systems
- Provider manuals
- Rate Changes
- Legal language changes
Kryptiq has many years of experience with Process Maturity at leading Blues plans, and has developed processes that make responding to demands of settlements like Thomas-Love straightforward. Kryptiq has developed Active Progress™ Consulting to help health plans mature their processes so that those same plans can complete projects like the response to this settlement in a timely manner. Kryptiq can help:
Let Kryptiq Active Progress™ help you today.
Or... please contact Kryptiq:
Kryptiq Active Progress™ Management Consulting
3600 NW John Olsen Place, Suite 300
Hillsboro, Oregon 97124
503.906.6060
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